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Medicare News
Lowering Age for Medicare May Help Offset Later Cost
of Caring for Uninsured
Older adults with chronic disease but no previous
insurance are costly to Medicare, study finds
July 11, 2007 A new study suggests that lowering
the age to become covered by Medicare would be at least partially offset
by avoiding the additional cost for the government of caring for those
with serious chronic disease that had no insurance before reaching age
65 and joining Medicare. It may also suggest the value of some other
national health care program that would assure adequate care for people
in the earliest stages of their illness.
Uninsured adults ages 59-64 diagnosed with
hypertension, diabetes, heart disease, or stroke report much higher
medical costs - 51 percent higher compared with their insured
counterparts - after becoming eligible for Medicare through age 72,
according to a new Commonwealth Fund-supported study by researchers at
Harvard Medical School.
Those who were uninsured also reported 13 percent
more doctor visits and 20 percent more hospitalizations than those who
were insured before Medicare. Rather than a one-time spike, elevated
health care use persisted through age 72. The study is published in the
July 12 issue of the New England Journal of Medicine.
This study highlights the importance of health
insurance coverage for all Americans to improve the efficiency of our
health care system, as well as the quality of our health care and health
outcomes, said Commonwealth Fund President Karen Davis.
Despite spending more than any other country on
health care, the U.S. does not do as well on quality, health outcomes,
equity, or access to care, due to our fragmented health care system. The
result is waste and inefficiency that costs thousands of lives and
millions of dollars every year.
These findings support the hypothesis that
previously uninsured adults used health services more intensively and
required costlier care as Medicare beneficiaries than they would have if
previously insured, say lead author J. Michael McWilliams, M.D., of
Harvard Medical School and his colleagues in the study, Use of Health
Services by Previously Uninsured Medicare Beneficiaries.
The authors note that poor control of high blood
pressure and glucose and cholesterol levels can cause life-threatening
complications such as heart attacks, strokes and kidney failure,
increasing the need for costly medical care, hospitalizations, and
medications.
McWilliams and his colleagues conclude that
uninsured adults who lacked regular care were probably undertreated
before age 65 for often asymptomatic but poorly controlled conditions
such as hypertension and hyperlipidemia [high cholesterol], and the
undertreatment probably contributed to health declines and a greater
need for services after age 65.
The authors say the study has important
implications for health care policy, concluding that the costs of
expanding health insurance coverage for uninsured adults before they
reach the age of 65 years may be partially offset by subsequent
reductions in health care use and spending for these adults after the
age of 65, particularly if they have cardiovascular disease or diabetes
before the age of 65 years."
The study is based on a nationally representative
sample of adults from the Health and Retirement study. The researchers
followed 5158 adults from 1992 through 2004, before and after they
became eligible for Medicare, comparing the health care use and
expenditures of those who were uninsured with those who were insured
before Medicare.
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